IMDC & FMDC, Bahria University

PROF PROFESSIONAL EXAMINATION-2014 FINAL YEAR MBBS

SEQs-SURGERY

Time allowed: 2 hr & 10 min Max: Marks: 50

Note:- ATTEMPT ALL QUESTIONS

Q 1. A married female of 30years presented with central abdominal periumbilical pain

for the last 24 hours. She has vomited thrice and reluctant to take any food. She is tender
over right lower quadrant of abdomen;

1. Enlist ten D/D?

2. What is your most likely clinical diagnosis?
3. How will you diagnose this disease?
4. What will be your treatment plan?

Q. 2 An adult of 25 years presents with Dysphagia. He seems otherwise healthy. His

barium studies show “bird beak” appearance at the lower end of esophagus

1. What are D/D of dysphagia?

2. What investigations you will advice to confirm underlying pathology?
3. What are treatment options?

Q. 3 A lady presented with pain , fever and jaundice. Her TLC is 1500cmm.
Ultrasound examination shows diated common bile duct.

1. What is your diagnosis?

2. What are relevant investigations you will prescribe?
3. How will you manage this case?

Q. 4 A female of 50 year presented with pain Rt. Upper quadrant which radiates to
inter-scapular region and tip of Rt. Shoulder.

1. What is your clinical diagnosis?

2. Enumerate differential diagnosis?
3. How will you investigate and treat this condition?

Q. 5 An obese lady of six children presented with periumbilical swelling. It is painless

and disappears on lying down on the bed.

1. What is your most likely clinical diagnosis?

2. What are clinical features?
3. How will you mange it?
Q. 6 A young motorist presented with H/O chest trauma. His breathing is laboured.
Auscultation reveals absent air entry on Rt. Chest.

1. How will you manage this patient in emergency?

2. What emergency investigations are needed?
3. What will be treatment of choice?

Q. 7 A female of 50 years presented with soft cystic swelling above hyoid bone. Swelling
moves upward while protruding of tongue.

1. What is D/D of Mid Line Neck swelling, enlist at least five?

2. What is your most likely diagnosis?
3. What is your investigation plan?

Q. 8 An elderly patient who was admitted in ICU for recent acute myocardial infarction.
His pulse is irregular. He suddenly develops pain in his Rt leg. Leg looks pale and cold
on touch.

1. What is your diagnosis?

2. What patho-physiology of this condition?
3. How you will investigate and manage this case?

Q. 9 A baby of 6 month presented with cleft lip and palate.

1. What pre-operated measures you will take?
2. What other diseases are associated with this anamoly?
3. How will you treated this patient?

Q. 10 A patient sustained head injury from fall. His Rt. Temporal region is Bruised and
Ipsilateral pupil is dilated.

1. What are D/D?

2. How will you manage him in OPD?
3. What will be definitive management of this patient?
 MCQs-SURGERY

Time allowed: 50 min Max: Marks: 50

Name…………………………………………………..Roll No…………………

Note:- ENCIRCLE THE CORRECT ANSWER

1. After intramuscular injection over Lt. Triceps muscles a young girl presented with
difficulty in Dorsiflexion of her wrist. What is most likely cause of this problem?

Extenser muscle diseases

Radial nerve injury
Medial nerve injury
Ulnar nerve damage
Axillary nerve damage

2. A young boy presented with a discharging sinus from his Rt. Tibia. He had fracture due
to road traffic accident four months back. What is your diagnosis?

a. Mal-union
b. Non-Union
c. Osteomylitis
d. Cellulitis
e. Malignancy

3. A lady of five kids presented with soft swelling over periumbilical region. It is non-
reducible and non tender. What is your diagnosis?

a. Lipoma badomen
b. Paraumbilical hernia
c. Any tumor
d. Incisional hernia
e. Ca stomach

4. A boy of 20years presented with pain fever and soft cystic mass mover his Rt. Iliac
fossaUltrasonography confirms cystic nature of mass. What is your diagnosis?

a. Appndicular Mass
b. Ceacal carcinoma
c. Appendicular abcess
d. Carcinoid tumor
e. Illeoceacal Uhron’s disease
5. An incisional hernia is best treated by
 a. Repair with catgut
b. Repair with prolene suture
c. Repair with onlay prolene mesh
d. Repair with steel wires
e. Conservative treatment

6. Vericose veins of the legs after DVT are best managed by

a. Injection selerotherapy
b. Multiple vernous ligations
c. Great sphanous vein stripping
d. No surgical excision of superficial vericosities
e. Laser ablation
7. A 70 years male who had recent heart attack developed severe pain left leg. Foot
appears pale and pulses are absent. What is the cause of this vascular emergency?

a. Abdominal aortic aneurysm

b. Rapture of aorta
c. Thromboembolism
d. Atherosclerosis
e. Dissected aortic aneurysm

8. IV fluids needed for resuscitation if an adult has

a. More than 15% burns

b. Less than 10% burns
c. 40% burs
d. Leas than 80%
e. Less than 5%

9. Pain control in benign disease is managed by following. Please mark incorrect option?
a. Pre-emptive analgesia in order to avoid phantom pain
b. Local anesthetic or steroid infiltration around nerve roots to reduce spasm
c. Transcutaneous nerve stimulators
d. Neuralgias respond to decompression of nerves
e. On demand analgesia
10. In a case of failed attempted Endotracheal intubation. The best choice is

a. Pass air way

b. Do tracheotomy
c. Laryngeal mask airway
d. Face mask
e. Naso tracheal intubation
11. Which of the following nerve is considered to be more vulnerable to injury during
parotid surgery?
 a. Hypoglossal nerve
b. Glossopharyngeal nerve
c. Fascial nerve
d. Vagus nerve
e. Lingual nerve

12. Which of the following is common cause of bacterial sialadenitis

a. Streptococcal pyogenes
b. Atypical mycobacteria
c. Staph aureus
d. Pseudomonas aeruginosa
e. Klebsiella

13. A young boy developed painful bilateral parotid swelling. Which of the following
complication can occur in this patient?

a. Salpingitis
b. Orehitis
c. Typhlitis
d. Proctitis
e. Oophoritis
14. A 44 year old lady was operated for simple MNG and subtotal thyroidectomy was
done. On 3rd post operative day she felt that pitch of her voice is decreased. Which
complication has occurred?

a. Damage to external Laryngeal nerve

b. Damage to recurrent laryngeal nerve
c. Damage to main vagal trunk
d. Damage to hypoglossal nerve
e. Hypocalcemia
15. A 02 year old boy was brought to OPD for a mid line cystic neck swelling lying just
below thyroid bone that moves with swallowing & tongue protrusion. What is likely
diagnosis?

a. Branchial cyst
b. Cervical cyst
c. Thyroglossal cyst
d. Cervical cyst
e. Dermoid cyst

16. Which of the following is commonest thyroid malignancy?

 a. Papillary thyroid carcinoma
b. Medulllary thyroid carcinoma
c. Anaplastic carcinoma
d. Thyroid lymphoma
e. Metastatic carcinoma

17. A 15 year old female presented in OPD having pain in Umbilicus that radiated to RIF.
She is also having nausea and anorexia. TLC was 11500. On examination when surgeon
presses LIF patient experiences pain in RIF and also tenderness and rebound tenderness
in RIF. What is likely diagnosis?

a. Acute appendicitis
b. Right ureteric colic
c. Ruptured ectopic pregnancy
d. Mittleschemerz
e. Perforated peptic ulcer

18. Which of the following is type of adynamic intestinal obstruction?

a. Adhesions
b. Paralytic ileus
c. Worms
d. Stones
e. Tumor

19. A 58 year old female was diagnosed as case of acute pancdreatitis. Which of the
following criteria is most effective in determining severity index?

a. Glasgow
b. Ranson
c. APACHE
d. POSSUM
e. Parsonet

20. Most common type of gall stones is

a. Pigment stones
b. Cholesterol stones
c. Mixed stones
d. Brown
e. Black

21. A 40 year old multiparous fatty female, presented in surgical OPD with history of
pain in RHC for few hours associated with few episodes of non bilious vomiting.
Examination showed tachycardia and tenderness in RHC. Which investigation will help
in diagnosis?

a. CXR
b. X-Ray abdomen
c. Ultra sound abdomen
d. TLC
e. Barium study

22. A 40 year old multiparous faty female, presented in surgical OPD with history of
recurrent attacks of pain in RHC especially after fatty meals and flatulent dyspepsia.
What is likely cause?

a. Acute cholecystitis
b. Acute pancreaitis
c. Acute peritonitis
d. Biliary colic
e. Perforated duodenal ulcer

23. Charcot’s triad refers to

a. Fever, Deranged LFTs, Anemia

b. Fever, pain right hypochondrium jaundice
c. Anemia, hepatomegaly, Jaundice
d. Anemia, pain right hypochondrium, jaundice
e. Anemia, fever, jaundice

24. A 35 year old female patient complains of dysphagia for last 6 months more for
liquids than solids. Which investigation will confirm diagnosis?

a. Barium Sallow
b. Barium meal
c. CT Scan
d. Chest X-Ray
e. Ultra sound chest
25. A 50 year old lady presented to surgical OPD complaining of progressive dysphagia,
weight loss and anemia. On examination patient is pale and emaciated. What is likely
diagnosis?

a. GORD
b. Achalsia
c. Ca Esophagus
d. Ca stomach
e. PUD
26. A patient presented in surgical OPD having severe cough especially at bed time and
regurgitation of undigested food material. He is also embarrassed by bad breath. What is
likely diagnosis?

a. Ca Esophagus
b. Pharyngeal pouch
c. Peptic stricture
d. Barrett’s Esophagus
e. GORD
27. Which of the following is considered to be pre-malignant lesion

a. Esophageal candidiasis
b. Barrett’s esophagus
c. Schatzki rings
d. Moniliasis
e. Mallory Weiss Tear

28. A young boy sustained cricket ball injury to his Rt. Temporal region. After 4 hours his
level of consciousness deteriorated on examination Rt. Pupil was dilated. What is your
clinical diagnosis?

a. Diffuse axonal injury

b. Sub-dural haematoma
c. Brain Laceration
d. Brain contusion
e. Extradural haematoma

29. CSF Rhinorechea after head injury is sign of . Mark the right optin?

a. Fracture of Post cranial fossa

b. Fracture of Middlecranial fossa
c. Fracture of Frontal bone
d. Fracture of Zygomaic Arch
e. Fracture ant. Cranial fossa

30. An Afghani of 50 years presented with pain Rt. Hypochondria. Ultrasonography

reveals cystic swelling well encapsulated in right lobe of liver. The most likely diagnosis
would be

a. Hepatocellular Carcinoma
b. Hydatied Cyst
c. Liver Cirrhosis
d. Liver Abcess
e. Metastatic Liver Disease
31. Lower respiratory tract is protected by following mechnasims. Mark the worng
statement?
 a. Closure of the laryngeal inlet
b. Closure of the false cords
c. Closure of the Glotis
d. Cessation of respiration
e. No cough reflex

32. After head injury to asses level of consciousness. What is he best clinical monitoring
scale in the ward?

a. Apachi scoring scale/system

b. Glasgow comma scale
c. Ranson’s criteria
d. Alvarado score
e. Kings college criteria

33. Cushing, Phenomenon is comprised of different features along with deterioration in

level of consciousness it’s comprised of. Select the right statement?

a. Bradycardia and Hypertension

b. Taechycardia and Hypertension
c. Arrthymias and Hypotension
d. Normal pulse rate and normaloension
e. Bradycardia and Hypotension
34. A baby with unilateral Clift lip presented in OPD. The best time of surgical repair is?

a. 5-6 months
b. 4-5 months
c. 6 months
d. 2-3 months
e. First month of life

35. After blunt injury to chest wall an elderly patients develop tension Pneumothorax.
Select the best management option?

a. Thoracic chest tube insertion

b. Tracheotomy
c. Endotracheal intubation
d. Urgent surgery
e. O2 with mask only

36. Puncture wound over left Ant. Chest wall, resulted in cardiac tamponade in a young
man after a street fight. What is best management option?
 a. Pericardiaocenteris/Needles aspiration
b. I/V fluids only
c. Blood transfusions
d. Thoracotomy
e. Laparotomy
37. A non healing ulcer over nasolabial found in a farmer is most likely. Mark to the right
option?

a. Basal Cell Carcinoma

b. Squamus Cell Carcinoma
c. Malanoma
d. Healing Ulcer
e. TB Ulcer
38. Normally metabolism in the body results in production of nitric oxide and carbon
dioxide. If a patient remains in state of shock for delayed time period. What will be the
outcome?

a. Lactic acidosis and hyperkalemia

b. Hyper carbia
c. Hyponatrimia
d. Hypocalcemia
e. Hypo albumenemia

39. Most patients in hypovolaemic shock will have cool, pale peripheries, with prolong
capillary refill time in distributive shock as in septic shock this time is. Mark right
option?

a. Normal
b. Delayed
c. Decreased or brisk
d. Increased
e. Non appreciable

40. Physiological exhaustion is the end result of shock in any patient with on going
traumatic haemorrhage. What will be the best management plan?

a. Avoid haemorrhage
b. IV analgesics
c. Cold IV infusates
d. Inj. Vit-K
e. Tranamenic acid intravenously

41. Platelets are very important haemostatic particles. What is its life span? Mark the
right option?

a. 1-2 days
 b. 2-3 days
c. 4-5 days
d. 7-10 days
e. 10-15 days

42. The most common fatal infectious complication of blood transfusion is

a. Malaria
b. Cytomagalovirus
c. Aids virus
d. Viral hepatitis
e. Typhoid fever

43 What percentage of total insensible loss of water from skin

a. 25%
b. 45%
c. 60%
d. 75%
e. 80%

44. A patient is on dialysis for last four months his renal function are impaired. Physician
noticed tall T waves on ECG paper. What is the reason for this abnormal T wave?

a. Hyperkalemia
b. Hypomagnicemia
c. Hypercholoremia
d. Hyponatriemia
e. Hypokalemia

45. A patient was managed by daily dressing and Debridement for one week, now wound
looks pink and granulation tissues are sprouting. You are planning to close it now to
minimize scar and contracture. This wound will heal by

a. Secondary intension healing

b. Tertiary intension healing
c. Reactionary healing
d. Delayed healing
e. Accelerated healing

46. A bed bound paraplegic patient was brought to hospital with bed sores over his
scarum. Below are different stages of decubitus ulcer. Mark the least true stage?

a. Non blenhable skin erythema

b. Partial thickness skin loss involving the epidermis
 c. Full thickness skin loss
d. Full thickness tissue loss involving muscles, bones, tendons and joints
e. Healthy healing wound edges

47. Venous ulcers in a patient with long standing varicose veins are most commonly due
to

a. Skin infections
b. Neuropathy
c. Trauma
d. Venous hypertension
e. Dermatitis

48. Synergistic spreading gangrene is caused by

a. Staphylococcal infections
b. Streptococcal infections
c. Clostidial infections
d. Poly microbial
e. Aerobics only
49. The best management of 5 cm liver abscess is

Antibiotic alone
Aspiration for culture and sensitivity
Per-cutaneous drainage and antibiotic therapy
Laparotomy and drainage of abscess
IV normal saline

50. Systemic inflammatory response syndrome and multiple organ dysfunction syndrome
is as a result of

a. Prostaglandins
b. Leucocytes
c. Red blood cells
d. Cytokines
e. Anti inflammatory mediators

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